动脉硬化与ApoE基因对贵州布依族、汉族老年轻度认知功能损害的影响研究

Mild cognitive impairment (MCI) is crucial for prevention and treatment of senile dementia. There are important scientific significance on exploring the different subtypes of the disease because of its diversity of outcome and characteristics of multi-factors. At present, the research results still existed in differences, which paid close attention to the influence factors of different subtypes of MCI for the elderly. There were connections between arterial stiffness, the allele of apolipoprotein E (ApoE) and part of the MCI and its subtypes found by the past studies.So, it should possess biological feasibility for exploring the combination between two independent factors on the influence of MCI and its subtypes. There are different characteristics between the Buyi and Han people in the living habits, language culture and inheritance and so on.The prevalence of MCI in this population may have its own characteristics.This paper will use prevalence study and case-control study based on the elderly of Buyi and Han nationalities in rural area of Guizhou, to compare the differences between the Buyi and Han population MCI prevalence, and to analyze the different influences on MCI and its subtypes which were caused by the polymorphism of ApoE gene, arterial stiffness and other risk factors for cardiovascular disease.Further, this paper aims at the interaction and impact on MCI and its subtypes for the elderly caused by the polymorphism distribution of ApoE gene and different degree of arterial stiffness, in order to analyze deeply the influence on MCI and its subtypes caused by the common cardiovascular risk factors for the elderly, to provide clues for the interaction mechanism and reasons, and to provide scientific reference for the early intervention of MCI and the prevention of dementia.

轻度认知功能损害（MCI）对防治老年痴呆有重要价值。鉴于MCI转归结局的多样性及多病因特点，对该病的不同亚型进行探索具有重要科学意义。目前，针对老年人不同亚型MCI的影响因素研究仍存在差异，动脉硬化、载脂蛋白E（ApoE）等位基因与MCI及部分亚型之间可能存在联系，故探讨两个独立因子之间的联合作用对MCI及其亚型的影响具备生物学生的可行性。布依族与汉族人群在生活习惯、语言文化、遗传等方面存在不同，其MCI患病可能具备自身特征。本研究拟采用基于贵州农村地区布依族、汉族老年人群的现况调查及病例对照研究，通过比较布依族、汉族人群MCI患病率差异，分析ApoE基因多态性、动脉硬化及其他相关心血管危险因子对MCI及其亚型的影响，并在此基础上重点研究ApoE基因多态性分布与不同动脉硬化程度对MCI的交互影响，旨在解析老年人群常见心血管危险因素对MCI及其亚型的影响，为其相互作用机制提供病因线索。

背景：老年痴呆是全球面临的重大慢性病防控挑战，而轻度认知功能损害（MCI）是早期诊断和干预痴呆的关键环节。动脉硬化、载脂蛋白E（ApoE）等位基因与MCI可能存在密切联系，且可能存在民族差异，有必要就动脉硬化与ApoE基因对MCI的影响进行探讨。. 研究内容：第一，调查贵州农村地区布依族、汉族老年人MCI及亚型患病率和影响因素，并了解其动脉硬化的患病状况；第二，分析老年人动脉硬化对MCI的影响；第三，探讨ApoE4基因与动脉硬化对MCI及其亚型的交互作用。. 结果及数据：第一，贵州少数民族农村社区老年人MCI患病率为17.2%，亚型以遗忘型MCI（aMCI）为主，其检出率为15.8%，与国内其他地区和前期团队在城市的调查结果相比，研究样本MCI及aMCI患病率处于较高水平，且布依族老年人MCI、aMCI患病率高于汉族；第二，农村老年人动脉僵硬度增高普遍，按照其测量指标baPWV>1400cm/s的标准判断，其动脉硬化的患病率约为91%，较大的年龄、高血压、脉压、TG异常、肥胖等与动脉硬化患病存在关联，动脉硬化是MCI患病的危险因素（OR=2.704，95%CI=1.035～7.064），且日常生活功能（ADL）状态是两者关联的中介效应因素；第三，民族、性别、家庭经济状况、体育锻炼、参与集体活动等是农村老年人aMCI的影响因素（P<0.05），其中布依族、女性表现为危险因素（OR>1），而较高收入、体育锻炼是保护性因素（OR<1）；第四，调查对象中ApoE3基因表达频率最高（占比接近70%），而ApoE2、ApoE4的表达频率相对较低，ApoE4基因和动脉硬化对老年人认知功能评分在血脂异常的老年人对象中有交互作用影响（F=6.878，P<0.01），这种影响主要针对注意力和计算力领域水平的下降有统计学意义，而在其他认知领域则未见到其交互影响存在。. 科学意义：开展动脉硬化的预防和干预，有利于及早预防和控制MCI的发生发展，尤其携带ApoE4基因型对象，同时更应该关注少数民族老年人群体的神经精神健康问题。